Tongue cancer is a form of head and neck cancer that begins when cells on the surface of the tongue grow and divide without control. The most common type is squamous cell carcinoma, which arises from the thin, flat cells lining the mouth and throat. While a search for images can provide initial insight, it is impossible to self-diagnose this condition based on visual inspection alone. Early detection significantly improves outcomes, making it imperative to consult a dentist or physician immediately if you notice any persistent changes in your mouth. This medical evaluation is the only way to accurately determine the nature of a suspicious lesion.
Visual Signs and Symptoms of Tongue Cancer
The visual appearance of tongue cancer lesions varies depending on their location: the oral tongue (the front two-thirds) or the base of the tongue (the back one-third). Oral tongue cancer is more frequently detected early because the lesions are visible and easily felt. These tumors often manifest as a persistent ulcer or sore that does not heal, usually lasting longer than two weeks.
A cancerous lesion may look like a grayish-pink or reddish ulcer that bleeds easily if touched. These lesions are often firm, feeling like a lump or thickened area on the side or underside of the tongue. White or red patches, known as leukoplakia and erythroplakia, can also signal potentially malignant changes. Erythroplakia, which presents as velvety red patches, carries a higher risk of turning cancerous than white patches.
Cancer at the base of the tongue is harder to detect visually during self-examination due to its location. Tumors in this area may cause persistent symptoms such as a sore throat that does not resolve or a feeling that something is constantly caught in the throat. Other signs include persistent numbness, difficulty or pain when swallowing, and sometimes pain in the ear on the same side. Unlike many benign mouth sores, cancerous lesions are often painless early on.
Differentiating Benign Oral Lesions
Many common, non-cancerous conditions can cause sores or discoloration on the tongue. A primary distinction lies in the symptom of pain and the duration. Benign sores are typically painful immediately, whereas a cancerous lesion may be painless until advanced.
Canker sores (aphthous ulcers) are common benign lesions, presenting as small, round sores with a white or yellowish center and a red border. These ulcers are often painful and usually resolve completely within 7 to 14 days. If a sore heals rapidly, it is highly unlikely to be cancerous.
Geographic tongue appears as smooth, reddish patches resembling a map, characterized by a migratory pattern that changes size and location over days or weeks. Traumatic lesions, caused by biting or irritation from a sharp tooth, heal quickly once the source of irritation is removed. Oral thrush, caused by a fungal overgrowth, appears as creamy white patches that can usually be wiped away, revealing a red, inflamed surface underneath.
Clinical Diagnosis and Staging
When a persistent or suspicious lesion is identified, a healthcare provider, such as a dentist or an otolaryngologist (ENT specialist), performs an initial examination. This includes visual inspection and palpation to check for firmness or an underlying mass. The definitive diagnosis of tongue cancer is established through a biopsy, where a small sample of the abnormal tissue is surgically removed and examined by a pathologist. This procedure confirms the presence of cancerous cells and identifies the specific cancer type.
Once cancer is confirmed, imaging tests are used for staging the disease, which determines the extent of the cancer’s spread. Computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans help determine the tumor’s size and whether it has spread to nearby lymph nodes or distant sites. The TNM staging system assesses three factors: Tumor size and depth (T), the presence of cancer in nearby lymph nodes (N), and whether the cancer has spread (Metastasis, M).
The T category uses criteria like the tumor’s size in centimeters and its depth of invasion (DOI) into the underlying tissue. For example, a tumor 2 cm or less with a DOI of 5 mm or less is classified as T1, indicating an early-stage lesion. Accurate staging guides the choice of treatment, whether it involves surgery, radiation therapy, or chemotherapy. Early-stage cancers, typically Stage I or II, are localized and have a better prognosis than advanced-stage disease.
Key Risk Factors and Prevention
Several factors increase the likelihood of developing tongue cancer, the most significant being the use of tobacco products, including smoking and smokeless tobacco. The chemical carcinogens in tobacco directly damage the cells lining the mouth, increasing the risk of malignant transformation. Heavy alcohol consumption is also a major factor, and combining it with tobacco use significantly increases the overall risk.
Another primary cause, particularly for cancers of the base of the tongue, is infection with high-risk types of the Human Papillomavirus (HPV), specifically HPV-16. This virus is transmitted through sexual contact and is responsible for a growing number of oropharyngeal cancers.
Prevention strategies focus on minimizing exposure to these known risk factors. Abstaining from all forms of tobacco and limiting alcohol intake are the most effective measures to reduce risk. The HPV vaccine is an important tool in prevention, protecting against the virus strains linked to this cancer. Regular dental checkups are also a proactive measure, as dentists and hygienists are often the first to identify subtle, early-stage lesions during routine oral cancer screenings.